US7270671B2 - Semi-automatic suture device for using surgical thread - Google Patents

Semi-automatic suture device for using surgical thread Download PDF

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US7270671B2
US7270671B2 US10/521,966 US52196605A US7270671B2 US 7270671 B2 US7270671 B2 US 7270671B2 US 52196605 A US52196605 A US 52196605A US 7270671 B2 US7270671 B2 US 7270671B2
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Prior art keywords
blocking
zone
thread
strands
suture
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US20050240203A1 (en
Inventor
Jean Fuseri
Yves Alimi
Frédéreic Mouret
Vincent Garitey
Régis Rieu
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Aix Marseille Universite
Centre National de la Recherche Scientifique CNRS
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Centre National de la Recherche Scientifique CNRS
Universite de la Mediterranee Aix Marseille II
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Assigned to CENTRE NATIONAL DE LA RESHERCHE SCIENTIFIQUE (CNRS), UNIVERSITE DE LA MEDITERRANEE (AIX-MARSEILLE II) reassignment CENTRE NATIONAL DE LA RESHERCHE SCIENTIFIQUE (CNRS) ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ALIMI, YVES, FUSERI, JEAN, MOURET, FREDERIC, RIEU, REGIS, GARITEY, VINCENT
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0454—Means for attaching and blocking the suture in the suture anchor the anchor being crimped or clamped on the suture

Definitions

  • the present invention relates to a semiautomatic implantable surgical device for suturing with surgical thread. More particularly, the present invention relates to a suture device including blocking means for blocking together two strands of thread in a suture.
  • the present invention relates still more particularly to a device for suturing by a minimally invasive surgical approach.
  • Minimally invasive surgery consists in making cutaneous and parietal incisions of small size and introducing instruments and viewing means such as a camera in order to perform an operation in video-assisted manner through orifices having a diameter lying in the range 3 millimeters (mm) to 12 mm by means of a hollow cylindrical instrument referred to as a “trocar”.
  • anastomoses are often made using sutures of surgical thread secured by knots. Tying a knot on an organ or a vessel constitutes a difficult step during surgery since:
  • the present invention seeks to provide a device for suturing using a thread, but offering an alternative to tying knots so as to make it easier to connect two strands of suture thread together, and making it possible significantly to reduce the time required for connecting said strands of thread together.
  • U.S. Pat. Nos. 5,669,917, 6,066,160, 6,077,277, 6,217,591, and 6,293,961 propose various devices enabling two strands of thread to be connected and blocked together instead of requiring the surgeon to tie knots. Nevertheless, in those prior devices, it is always necessary to put the thread under tension in order to tighten the suture before connecting and blocking together the two strands of thread. During this step, it is not possible for the tension exerted on the thread by the surgeon to be controlled automatically in any way.
  • the object of the present invention is thus to provide a surgical suture device that is compatible with using conventional suture thread so as to conserve the benefits of conventional surgery and increase the confidence of the surgeon, while remedying the drawbacks of prior devices.
  • an object of the present invention is to provide a suture device that makes it possible to block suture threads quickly and reliably in a manner that is semiautomatic for the surgeon.
  • Another object of the present invention is to provide a suture device such that the suture made thereby is of reversible or removable character, and in particular can be cut almost instantaneously without any risk of damaging the surrounding tissues.
  • the present invention provides a suture device comprising: blocking means for connecting together two strands of thread in a blocking zone; and controlled tensioning means for controlled tensioning of said thread, and suitable, after the two strands of said thread have been blocked together using said blocking means, for exerting tension on the thread at a first predetermined tension value.
  • the present invention provides an implantable device for semiautomatic suturing using a surgical thread, the suturing enabling biological and/or artificial tissues to be united, the device comprising: blocking means enabling two strands of the thread of a suture to be connected together in a blocking zone; a bearing element having a bearing surface for bearing against the tissues to be sutured together; and controlled tensioning means for applying controlled tensioning to said thread, and suitable, after the two strands of said thread have been blocked together using said blocking means, for exerting a tension at a first predetermined tension value, with the junction between said bearing element and said blocking zone of the device being provided by said controlled tensioning means.
  • Two strands of thread are said herein to be “connected together” when the two strands cannot move relative to each other in said blocking zone, i.e. they are not necessarily in contact with each other in said blocking zone.
  • the device can be used to unite pieces of biological tissue, one or more pieces of biological tissue with one or more pieces of artificial tissue, or solely pieces of artificial tissue.
  • said blocking means and said tensioning means are suitable for co-operating so that two strands of suture thread are blocked together before exerting said first predetermined tension value, and once the two strands have been blocked together, the device tensions the suture threads at said first predetermined tension value in automatic manner.
  • said suture thread enables the two pieces of tissue, or a piece of tissue and a prosthesis, that are to be united by said suture to be moved together effectively by tightening the thread.
  • said tissue can be biological or artificial.
  • controlled tensioning is used herein to mean tensioning at a said first known and predetermined tension value, which tensioning can be applied automatically using said tensioning means, and no longer depends on the initial tension exerted manually by the surgeon on the thread or on a device; that is why the device of the invention is said to be “semiautomatic”.
  • the fact of tensioning the suture threads to a said first predetermined tension value in controlled manner gives the device dynamometric behavior and contributes to the effectiveness of the device and the speed and ease of suturing using the device.
  • the dynamometric behavior of the device of the invention serves to ensure that tensioning is applied appropriately, uniformly, reliably, and repetitively on the threads that are to constitute the suture. Having tension that is uniform makes it possible to distribute forces evenly over the sutured tissues, and thus to minimize aggression to said tissues.
  • Said first predetermined tension value may preferably lie in the range 0.1 newtons (N) to 10 N, depending on the site of surgery, i.e. depending on the type of tissue to be sutured and depending on the type of suture thread used, and in particular it may be about 2 N which corresponds to the mean tension value of a suture made between a vessel and a vascular prosthesis during conventional surgery under good operating conditions.
  • the blocking of said strands of thread using said blocking means is suitable for automatically triggering said tensioning of the thread at a said first predetermined tension value, preferably lying in the range 0.1 N to 10 N.
  • said controlled tensioning means are suitable for co-operating with:
  • said tensioning means for adjusting the distance between a said zone of contact on said tissue and said blocking zone comprise said junction means between said contact zone and said blocking zone.
  • Said first controlled tension value is thus achieved by adjusting the distance between two zones, namely a contact zone and a blocking zone, by means of a junction element, which adjustment is a function both of said initial distance between said two zones and of the initial tension of the thread as exerted by the surgeon prior to blocking.
  • tensioning the threads is preferably triggered automatically by causing said thread blocking means to operate. Nevertheless, such triggering can be implemented manually by the operator, particularly by relaxing a pressure being exerted by the operator for maintaining said initial pressure manually.
  • the device of the invention is advantageously put into contact with the tissue to be sutured by means of a placing instrument known as an “ancillary”.
  • the suture device of the invention is thus suitable for co-operating with said placing instrument to which it is secured prior to said blocking, preferably being secured via a top portion corresponding to said blocking zone, and, where appropriate, tensioning of the thread after blocking may be triggered manually using said placing instrument.
  • the placing instrument may also serve to cut the ends of the strands of suture thread over the thread blocking zone at a distance lying in the range 1 mm to 10 mm, and in particular 5 mm to 6 mm from the blocking zone, after the threads have been blocked together and depending on the anatomatic site of the surgery.
  • said tensioning means comprise means for establishing a resilient junction between said contact zone and said blocking zone so as to enable the distance to be adjusted between:
  • force equilibrium is used herein to mean equilibrium between the force exerted by the junction means and the tension of the suture.
  • Said first link element and/or said first spacer element may be secured to said placing instrument or to said suture device proper.
  • junction means are made of a material that presents elasticity, and said suture device is secured to the placing instrument via said blocking zone such that:
  • the blocking zone and the contact zone can be brought towards each other to said initial distance (L) even before the threads are inserted into the device.
  • the device is then pre-stressed when in position in its placing instrument.
  • said initial distance may be obtained using a first link element such as a tab suitable for initially connecting said blocking zone and said tissue contact zone, and said adjusted final distance of said blocking zone relative to said contact zone can be implemented by releasing said first link element connecting together said blocking zone and said contact zone of the device.
  • a first link element such as a tab suitable for initially connecting said blocking zone and said tissue contact zone
  • said first link element forms a part of said suture device of the invention, and release of said link element can be triggered manually, in particular using the instrument for placing the device of the invention, or else it can be triggered automatically, if said first link element is also connected to said blocking means in such a manner as to release first link element once said blocking means have been locked.
  • said first link element is suitable for co-operating with said blocking means so that said first link element is released once said strands of thread have been blocked together with the help of said blocking means.
  • the device includes resilient junction means and it is suitable for co-operating with a placing instrument to which it is preferably secured via a top portion corresponding to said blocking zone, such that:
  • resilient junction means at rest is used to mean that said resilient means are not under stress.
  • junction means are made of a material that presents elasticity, and the displacement of said blocking zone and said contact zone is controlled by the placing instrument which is secured to said blocking zone in such a manner that:
  • the device of the invention is of a shape such that after suturing has been performed, the thread is unencumbered so as to be capable of being cut between said blocking zone and said suture orifices in said tissue, and preferably between said blocking zone and said contact zone.
  • the device of the invention includes guide means enabling the two strands of thread to be held in a position where they are spaced apart from each other laterally at the suture orifices in said tissue.
  • Said guide means are more particularly suitable for maintaining the two threads in a spaced-apart position when tension is exerted on said thread after the strands of thread have been connected together at said blocking zone by said blocking means. It will be understood that said guide means then make it possible to avoid tearing the tissue at the orifices where the thread passes through said tissue when tension is exerted on the thread after the ends of the thread have been blocked together.
  • the device of the invention has said guide means at said thrust surface defining said zone of contact between the device and the tissue.
  • said guide means comprise at least one notch formed in said bearing surface defining said contact zone.
  • said bearing surface has a piece of fabric made of biocompatible materials and suitable for having two strands of thread pass therethrough, and suitable for keeping them spaced apart.
  • the fabric may be constituted in particular by a synthetic material that facilitates hemostasis and that preserves the integrity of the biological or synthetic tissues to be sutured.
  • it an be constituted by a piece of vascular prosthesis, a compress, or a swab.
  • a “pledget” is a piece of fabric, in particular made of Dacron® or Teflon®, through which the surgeon passes the two strands of thread separately, and it acts as an intermediary between the knots and the tissue to be sutured.
  • the covering of biocompatible material acting as means for guiding and separating the strands of the suture thread where they leave the sutured tissues also acts as a traditional pledget, but it is integrated in the device, thereby making contact between the device and the tissue gentler and less traumatic, and performing the pledget function of facilitating hemostasis and preserving the integrity of the sutured tissues.
  • said blocking means comprise two blocking surfaces which can move between a spaced-apart position in which it is possible to insert said strands of suture thread between said two blocking surfaces, and which is suitable for blocking the strands of thread together by friction between the threads and said two blocking surfaces once the surfaces are in the close-together, blocking position, with the displacement of said two blocking surfaces between said spaced-apart position and said close-together position preferably automatically triggering said tensioning of the threads.
  • said blocking surfaces need to present the following characteristics:
  • said blocking of the strands of thread using said blocking means is suitable for being triggered automatically.
  • Automatic triggering of the blocking mechanism can take place via the instrument that is used for inserting and placing the device of the invention at the suture.
  • the automatic triggering of said blocking means can take place when the device of the invention is put into contact with the tissues for suturing with a bearing force that is greater than a second predetermined value lying in the range 0.2 N to 20 N, and in particular greater than 10 N.
  • This bearing force estimated at 10 N corresponds to the force developed by a surgeon when pulling on the suture threads while making a first knot in a traditional suture for performing anastomosis of the abdominal aorta. The magnitude of this bearing force naturally varies with the type of surgery being performed and with the type of suture thread being used.
  • said blocking means comprise two jaws that are elastically connected together and that form said blocking surfaces, which jaws are spaced apart by a second spacer element, and said second spacer element is suitable for being released by being disengaged or by being broken, thereby allowing said blocking surfaces to move towards each other and block said strands of thread.
  • Said second spacer element may be an element of said suture device itself, or of said placing instrument.
  • said second spacer element is suitable for being released automatically, preferably by said placing instrument pressing against said second spacer element, whenever said bearing surface of the device exerts pressure on the tissues that is greater than a said second predetermined value preferably lying in the range 0.2 N to 20 N, and more preferably of at least 10 N.
  • said second spacer element is suitable for being released by automatically triggering the release of said first link element between said blocking zone and said contact zone of the device so that said zones adopt said adjusted final distance that enables a said control tension to be exerted on said thread.
  • the bearing force exerted at the base of the device of the invention against the tissues enables said second spacer element to be released, thereby preferably triggering tensioning of the thread after said strands of thread have been blocked, tensioning being at a said first tension value, by releasing, where appropriate, said first link element for maintaining the fixed spacing between said blocking zone and said contact zone at said initial distance, so that said blocking and contact zones adopt a said adjusted distance.
  • said blocking means comprise projecting elements that are preferably of circular section, more preferably of cylindrical shape, having the ends of the strands of thread for connection together wound thereabout. More particularly, said blocking can be achieved by moving said projecting elements towards each other or away from each other.
  • said blocking means include a blocking orifice in said blocking zone, said blocking orifice co-operating with a second blocking element comprising a screw, a rivet, a pushbutton, or indeed a jam cleat.
  • said blocking means comprise means for sticking, melting, heat-sealing, or crimping the two strands of thread together in a said blocking zone.
  • the blocking between said strands of thread must be capable of withstanding a traction force lying in the range 0.5 N to 50 N, and in particular of about 20 N to 30 N, with the suture thread breaking at a higher force.
  • an alternative is to provide blocking means in such a manner that the blocking means can be unlocked with an instrument, thereby releasing the threads from being blocked together.
  • the term “implantable device” is used to mean a device of size and of biocompatible constituent materials that enable it to be implanted in the human body, and more particularly implanted for the long term, inside the human body, i.e. for a duration of more than 30 days.
  • the term “implantable by a minimally invasive approach” is used to mean that the device of the invention is sufficiently small to enable it to be implanted by a minimally invasive approach, and more particularly through a trocar, in particular a trocar having a diameter lying in the range 2 mm to 20 mm. Still more particularly, the device of the invention presents dimensions in terms of height and width that lie in the range 2 mm to 20 mm, and preferably in the range 5 mm to 10 mm.
  • a device of the invention can be used in minimally invasive surgery, in particular in robot-assisted surgery, and also in conventional surgery. Depending on the degree of miniaturization of the device, use thereof can be envisaged in various types of minimally invasive surgery, such as, for example:
  • the device of the invention presents a mechanical structure that is simple and comprises, at least in part, and preferably completely, said bearing element, said blocking means, and said controlled tensioning means, forming a single integrally-formed mechanical part.
  • the material constituting the elements making up the device of the invention is a biocompatible material.
  • Materials of this type can be metals, plastics, or composites, and are known to the person skilled in the art. Some are given by way of example in the detailed description below.
  • FIGS. 1 to 4 show a first variant embodiment of a U-shaped suture device of the invention, with the device being shown in FIG. 1 held stationary on an ancillary 12 prior to being put into place.
  • the device is shown at the moment the ancillary presses against the top portion of the device immediately prior to the threads being blocked together.
  • FIG. 3 the device is shown while blocking is taking place.
  • FIG. 4 the ancillary 12 has been removed and the suture device 11 is shown after blocking has taken place.
  • FIGS. 5 to 7 show a second variant embodiment of a U-shaped suture device.
  • the device is shown held in place in its placing ancillary 12 .
  • Said ancillary is shown in face view in FIG. 6 and in side view in FIG. 7 .
  • FIGS. 1-3 and 5 - 7 said ancillary is shown purely diagrammatically, and only the bottom portion thereof that co-operates with the device.
  • FIGS. 8 to 10 show a second variant embodiment of a suture device of the invention comprising two plates interconnected by a conical spring which is shown in its initial position prior to blocking in FIG. 8 , then in its blocking position in FIG. 9 , and finally in the tensioning position of the device in FIG. 10 .
  • FIG. 11 shows a variant configuration for the notch 7 1 constituting the guide means in said bearing surface 4 1 ,
  • FIGS. 1 to 11 the suture device of the invention is shown diagrammatically so as to present its various component elements more clearly.
  • the device of the invention is U-shaped and comprises:
  • the entire device can be made of biocompatible materials that are metals, plastics, or composites, and in particular it can be made of 316L steel, of titanium, or of polypropylene.
  • the space between the two branches of U has only two strands of thread passing therethrough, which strands can therefore be cut in this location, should that be necessary.
  • Said first tension value exerted by the device depends on a dimensional parameter, in particular on the section of the hairpin junction elements 4 3 and on the nature of the material used. It is preferably about 2 N for an application to surgery of the abdominal aorta using threads made of polypropylene 4.0.
  • FIGS. 1 to 4 are diagrams showing a suture device of the invention that is U-shaped in this first embodiment described below.
  • the top branch 4 2 defines a blocking zone having two jaws 2 that are initially open, i.e. spaced apart, serving to block the threads 3 1 and 3 2 by the threads rubbing against two adjacent and complementary surface 2 1 and 2 2 on respective ones of the two jaws 2 when said two complementary surfaces 2 1 and 2 2 close against each other with the threads thus being blocked between them.
  • the two jaws 2 are made of polypropylene, for example, and they are resiliently connected together, their two complementary surfaces 2 1 and 2 2 being initially held spaced apart by a spacer tab 2 3 .
  • the spacer tab 2 3 is secured to one of the jaws 2 at one end, while its other end carries a tooth 2 5 which co-operates with a notch 2 4 in the second jaw so that said two complementary surfaces 2 1 and 2 2 close against each other when said tooth 2 5 of the tab 2 3 is disengaged from the notch 2 4 , thereby releasing the two jaws 2 .
  • Said complementary structures 2 1 and 2 2 of the two jaws 2 are preferably of curved shape, forming on their surfaces paths towards the threads that are as long as possible so as to maximize the contact areas with the threads, so that the threads are blocked by friction than rather by clamping, so as to avoid damaging the threads.
  • the bottom branch 4 1 includes a central notch 7 1 , itself covered on its underside by a pledget 7 2 made of Dacron® or Teflon® serving to hold the threads 3 1 and 3 2 apart at the orifices 6 1 and 6 2 where they leave the tissues for suturing together, the spacing between equal to 3 mm to 5 mm, for example, thereby preserving the integrity of said tissues and facilitating hemostasis.
  • a pledget 7 2 made of Dacron® or Teflon® serving to hold the threads 3 1 and 3 2 apart at the orifices 6 1 and 6 2 where they leave the tissues for suturing together, the spacing between equal to 3 mm to 5 mm, for example, thereby preserving the integrity of said tissues and facilitating hemostasis.
  • the bottom branch 4 1 forming the zone of contact with the tissue, is connected to the top branch forming the blocking zone 4 2 by the resilient junction zone 4 3 and also by a first link element or link rod 5 1 .
  • Said link rod 5 1 has one of its ends secured to said bottom branch 4 1 , and at its other end it carries a second tooth 5 3 which co-operates with a second notch 2 6 in the top branch 4 2 , said second notch 2 6 being a lateral notch, i.e. a notch in one of the sides of the top branch 4 2 .
  • the suture device 1 1 co-operates with an ancillary 1 2 on which it is held stationary.
  • One of the jaws 2 (or both jaws 2 ) of the top branch 4 2 is (or are) held relative to the ancillary 1 2 , e.g. in a hollow housing 8 1 in which the jaw 2 is initially fitted and/or blocked.
  • the top and bottom branches 4 1 and 4 2 are in a natural rest position in which they are spaced apart by a distance L+a.
  • the device When the link rod 5 1 is engaged in said lateral second notch 2 6 of the top branch, the device takes up a compressed state, and the distance between the two branches 4 1 and 4 2 is reduced, and corresponds to said initial distance L immediately before and during blocking.
  • the suture device can be lowered by the device sliding along the threads 3 1 and 3 2 passing through the pledget 7 2 and the space defined between the two jaws 2 and the spacer tab 2 3 (see FIG. 1 ).
  • the threads 3 1 and 3 2 are then under low tension and the distance between the two branch or blocking zone 4 2 and the bottom branch or contact zone 4 1 corresponds to said initial distance L which is maintained by the connection rod 5 1 .
  • the surgeon presses the device 1 1 against the tissues to be sutured by means of the placing instrument 1 2 .
  • the pusher element 8 2 of the ancillary provided for this purpose comes to press against the spacer tab 2 3 , thereby causing the spacer tab 2 3 to bend in such a manner that its tooth or projection 2 5 moves out from the notch 2 4 ( FIG. 2 ), thereby triggering the two resiliently interconnected jaws 2 to move towards each other and press against each other so as to block the threads 3 1 and 3 2 between their complementary surfaces 2 1 , 2 2 ( FIG. 3 ).
  • the threads 3 1 and 3 2 are blocked at a tension value that corresponds to the tension initially exerted by the surgeon on the threads while pushing the device against the tissues to be sutured together, and the distance between the contact zone of the bottom branch 4 1 and the blocking zone of the top branch 4 2 is L.
  • the resilient junction element 4 3 between the bottom branch 4 1 and the top branch 4 2 is designed in such a manner that when the distance between the bottom and top branches 4 1 and 4 2 is L ⁇ b with b ⁇ a, the two branches exert a tension having said first predetermined tension value, in particular lying in the range 0.1 N to 10 N, and more particularly having a value of 2 N, as explained above.
  • the threads can then be cut a few millimeters above said blocking zone 4 2 , in particular 5 mm to 6 mm above, with the threads thus being blocked together and under tension at said selected first predetermined value as obtained as a function of the way in which the suture device is made and in particular the way in which the junction element 4 3 between the bottom and top branches 4 1 and 4 2 is made.
  • the threads 3 1 and 3 2 are thus blocked together automatically when the suture device comes into contact with the tissues that are to be sutured together and a bearing force is exerted on said device having a said second predetermined value, which in this case is 10 N.
  • This value of 10 N corresponds to the force exerted by a vascular surgeon when pulling on the suture threads in order to tie a knot in a suture in the usual way. It should be observed that, prior to blocking, this initial 10 N bearing force is supported by the link rod 5 1 , which keeps the bottom and top branches 4 1 and 4 2 spaced apart in spite of said bearing force.
  • the ancillary 1 2 includes a spacer element 5 2 which prevents the bottom branch 4 1 with the device contact zone from moving too close to the top branch 4 2 with the blocking zones, i.e. approaching to a distance of less than L, so that the bottom branch 4 1 or contact zone 4 1 can be pressed against the tissue for suturing without any risk of leading to anticipated disengagement, in particular by the link rod 5 1 twisting.
  • FIGS. 5 to 7 there is shown a second embodiment of the first variant of a U-shaped suture device, which differs from the first variant as shown in FIGS. 1 to 4 as follows:
  • said second spacer element 2 3 for spacing apart the two jaws 2 constituting said blocking zone, no longer forms a part of the suture device 1 1 proper, but is integrated in the placing instrument 1 2 ;
  • the suture device 1 1 of FIGS. 5 to 7 is held stationary on the placing instrument 1 2 via said blocking zone 2 . More particularly, each of the jaws 2 is held in the spaced-apart position using the spacer bar 2 3 of the placing instrument 1 2 , with the ends 2 10 and 2 11 of the bar being received in grooves 2 7 in each of the two jaws 2 .
  • the two jaws 2 in the spaced-apart position have their bottom faces coming to bear against the top faces at the top ends of each of said two first spacer elements 5 2 of the ancillary, and the top faces of the two jaws 2 are held by a transverse bar 9 1 of the ancillary 1 2 .
  • the bottom branch 4 1 defining the contact zone of the device need not necessarily press against the bottom end of said spacer element 5 2 of the ancillary.
  • the height of said spacer element 5 2 of the ancillary corresponds to said initial blocking distance L, such that said first spacer element 5 2 of the ancillary 1 2 makes it possible, when the contact zone 4 1 of the device is brought into contact with the tissues to be sutured together, and is then pressed thereagainst, to limit the bending of the intermediate junction element 4 3 of the device so as to maintain the distance between the blocking zone 4 2 and the contact zone 4 1 equal to said initial distance L.
  • This initial distance L between the top blocking zone 4 2 and the bottom contact zone 4 1 corresponds to the mean value of the spacing (L ⁇ b) that needs to be maintained between these two zones of the device in order to ensure that the suture threads have said first predetermined tension value after being blocked together.
  • the two jaws 2 are spaced apart by the spacer rod 2 3 of the ancillary, with the ends of the rod being received in the grooves 2 7 in each of the two jaws 2 .
  • the grooves 2 7 in the jaws 2 are symmetrical and designed to be of depth that varies from a deep end 2 8 towards a shallow end 2 9 , such that:
  • the width of the two jaws 2 after they have moved together in this way is less than the distance l between the top ends of said two first spacer elements 5 2 of the ancillary 1 2 , so the ancillary can be withdrawn and separated from the device by being pulled upwards, the spacing between the contact zone 4 1 and the blocking zone 4 2 then no longer being controlled by said first spacer element 5 2 of the ancillary 1 2 , whereupon it is said tension of said first predetermined value that is exerted by the top and bottom branches 4 1 and 4 2 of the device under the effect of the elasticity of the junction element 4 3 that acts on the blocked-together threads, and in particular a said first tension value of 2 N.
  • the device is constituted by:
  • a device of the invention comprises:
  • suture threads pass inside the spring between said first and second plates.
  • the blocking zone 4 2 is preferably smaller in size than the contact element 4 1 .
  • the spring occupies a minimum amount of space in the height direction.
  • the dynamometer behavior is provided by the predefined stiffness of the spring.
  • This second variant embodiment with a frustoconical spring 4 3 differs from the U-shaped first embodiment of FIGS. 1 to 4 essentially by the fact that the intermediate junction element 4 3 is constituted by a said spring 4 3 of frustoconical envelope.
  • the blocking zone 4 2 is likewise constituted by two interconnected jaws.
  • Said blocking zone 4 2 is constituted by two resiliently-connected jaws 2 that are held spaced apart by a spacer rod 2 3 secured at one of its ends to one of the two jaws and co-operating at its opposite end with a notch 2 4 in the second jaw.
  • the two jaws 2 are thus held spaced apart and can thus be held in place on a placing instrument 1 2 . Thereafter, when a bearing force is exerted on the spacer rod 2 3 , it bends and comes out of the notch 2 4 in the second jaw 2 , such that the complementary surfaces 2 1 and 2 2 on the two jaws 2 can move towards each other and block the threads ( FIG. 9 ).
  • connection rod 5 1 can become disengaged so that the distance between the first plate 4 1 and the second plate 4 2 is then controlled solely by the tension exerted by the connection spring 4 3 .
  • the connecting spring 4 3 is designed in such a manner that it exerts a tension having a said first value, in particular 2 N, when it goes away said initial distance L between the contact and blocking zones at the time of blocking in order to adopt a said final distance L ⁇ b, as explained above.
  • the pressure exerted on the ancillary 1 2 thus causes the suture threads to be blocked together, after which it triggers tensioning of the suture threads once blocked together at a said first predetermined value.
  • the suture device is such that:
  • values for L, a and b can be as follows:
  • T 1 the tension being exerted by the surgeon on the suture threads
  • T 0 the first predetermined tension value, e.g. 2 N
  • L the length of the strands of thread between said contact zone and said blocking zone
  • the device When, after blocking, tensioning of the threads by the device is triggered, the device will compress under the action of the tension T 1 in the threads, and the distance between said contact zone and said blocking zone will take on a value that is less than L, i.e. L ⁇ b, where b ⁇ a.
  • the tension exerted by the device on the threads is thus equal to T 0 and the device prevents the threads from compressing beyond the distance L ⁇ b, where b corresponds to the shortening of the strands of thread under the effect of the difference in tension T 1 -T 0 .
  • FIG. 11 shows a variant embodiment of the guide means in said contact zone 1 having a said notch 7 1 that is in the form of a middle slot on the middle axis of said blocking zone together with two zones 7 3 that are disposed symmetrically about said middle slot, said two said symmetrical zones 7 3 comprising or defining retaining abutments for holding the two strands of thread 3 1 and 3 2 in a spaced-apart position where they pass through said zones, respectively.
  • Said symmetrical zone 7 3 of the notch 7 1 are spaced apart so as to allow the two strands of thread 3 1 and 3 2 to be tensioned on the axes of said suture orifices 6 1 , 6 2 so as to avoid applying any stresses to said suture orifices when exerting tension on the thread.
  • the suture device of the invention when applied to minimally invasive surgery can be put into place, for example, using a placing instrument 1 2 acting through a trocar having a diameter of 2 mm to 12 mm, said device having a said bearing surface and a said blocking zone which lie within a rectangular area of 2 mm 2 to 40 mm 2 and that are spaced apart by a maximum height of 10 mm.

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
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  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Materials For Medical Uses (AREA)
US10/521,966 2002-08-06 2003-08-05 Semi-automatic suture device for using surgical thread Expired - Fee Related US7270671B2 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR0209972A FR2843291B1 (fr) 2002-08-06 2002-08-06 Dispositif semi-automatique de realisation de suture a l'aide de fil chirurgical
FR02/09972 2002-08-06
PCT/FR2003/002459 WO2004014235A2 (fr) 2002-08-06 2003-08-05 Dispositif semi-automatique de blocage et de tension d’un fil de suture chirurgical

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US20050240203A1 US20050240203A1 (en) 2005-10-27
US7270671B2 true US7270671B2 (en) 2007-09-18

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US (1) US7270671B2 (de)
EP (1) EP1526813A2 (de)
JP (1) JP2005534441A (de)
CN (1) CN1674830A (de)
AU (1) AU2003274223A1 (de)
CA (1) CA2494586A1 (de)
FR (1) FR2843291B1 (de)
WO (1) WO2004014235A2 (de)
ZA (1) ZA200500909B (de)

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WO2009052509A1 (en) 2007-10-18 2009-04-23 Mitralsolutions, Inc. Implantable purse string suture tensioning device
US8663249B2 (en) 2010-04-29 2014-03-04 Vinay Badhwar Automatic suturing apparatus and methods of use
US9119614B2 (en) 2012-02-16 2015-09-01 Cook Medical Technologies Llc Suture retention device
US20170105717A1 (en) * 2012-12-12 2017-04-20 Cook Medical Technologies Llc Suture retention mechanism

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US8414599B1 (en) 2007-12-31 2013-04-09 Dallen Medical, Inc. Dynamic suture tensioning device and methods
US8613755B1 (en) * 2008-03-18 2013-12-24 Dallen Medical, Inc. Knotless dynamic suture tensioning device and methods
US8579901B1 (en) 2009-06-17 2013-11-12 Dallen Medical, Inc. Suture band buckle and methods
US8715297B1 (en) 2009-07-14 2014-05-06 Dallen Medical, Inc. Flat suture banding system and methods
US8668696B2 (en) 2009-08-20 2014-03-11 Dallen Medical, Inc. Low friction buckle tightening systems and methods
US8617207B1 (en) 2010-05-14 2013-12-31 University Of South Florida Surgical needle with jam cleat
US8974456B2 (en) 2011-05-19 2015-03-10 Dallen Medical, Inc. Hybrid medical device implant with migration management

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US3931821A (en) 1972-11-24 1976-01-13 Bio-Medicus, Inc. Suture bridges
FR2628964A1 (fr) 1988-03-22 1989-09-29 Roux Martial Dispositifs de mise en place et de fixation des canules sur le coeur ou les gros vaisseaux en vue de realiser une circulation extracorporelle pour la chirurgie cardiaque
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WO2009052509A1 (en) 2007-10-18 2009-04-23 Mitralsolutions, Inc. Implantable purse string suture tensioning device
US20100305609A1 (en) * 2007-10-18 2010-12-02 Cartledge Richard G Implantable purse string suture tensioning device
US8529589B2 (en) * 2007-10-18 2013-09-10 St. Jude Medical, Cardiology Division, Inc. Implantable purse string suture tensioning device
AU2008311802B2 (en) * 2007-10-18 2014-01-23 St. Jude Medical, Cardiology Division, Inc. Implantable purse string suture tensioning device
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US8663249B2 (en) 2010-04-29 2014-03-04 Vinay Badhwar Automatic suturing apparatus and methods of use
US9357999B2 (en) 2010-04-29 2016-06-07 Vinay Badhwar Automatic suturing apparatus and methods of use
US9119614B2 (en) 2012-02-16 2015-09-01 Cook Medical Technologies Llc Suture retention device
US20170105717A1 (en) * 2012-12-12 2017-04-20 Cook Medical Technologies Llc Suture retention mechanism
US10631846B2 (en) * 2012-12-12 2020-04-28 Cook Medical Technologies Llc Suture retention mechanism

Also Published As

Publication number Publication date
EP1526813A2 (de) 2005-05-04
US20050240203A1 (en) 2005-10-27
AU2003274223A1 (en) 2004-02-25
FR2843291B1 (fr) 2005-06-03
FR2843291A1 (fr) 2004-02-13
ZA200500909B (en) 2005-08-26
JP2005534441A (ja) 2005-11-17
WO2004014235A3 (fr) 2004-04-08
WO2004014235A2 (fr) 2004-02-19
CN1674830A (zh) 2005-09-28
CA2494586A1 (fr) 2004-02-19

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